title: Spontaneous delayed migration/shortening of the pipeline embolization device: report of 5 cases.
abstract: Five patients were found to have spontaneous delayed migration/shortening of their Pipeline Embolization Devices on follow-up angiography. The device migrated proximally in 4 patients and distally in 1 patient. One patient had a subarachnoid hemorrhage and died as a result of migration of the Pipeline Embolization Device, and another patient presented with complete MCA occlusion and was left severely disabled. Mismatch in arterial diameter between inflow and outflow vessels was a constant finding. Migration of the Pipeline Embolization Device was managed conservatively, with additional placement of the device, or with parent vessel occlusion. Obtaining complete expansion of the embolization device by using a longer device, increasing vessel coverage, using adjunctive aneurysm coiling, and avoiding dragging and stretching of the device are important preventive measures. Neurointerventionalists should be aware of this potentially fatal complication and take all necessary preventive measures.
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania.
authors.forename: N
authors.initials: N
authors.lastname: Chalouhi
authors.forename: S I
authors.initials: SI
authors.lastname: Tjoumakaris
authors.forename: L F
authors.initials: LF
authors.lastname: Gonzalez
authors.forename: D
authors.initials: D
authors.lastname: Hasan
authors.forename: P J
authors.initials: PJ
authors.lastname: Pema
authors.forename: G
authors.initials: G
authors.lastname: Gould
authors.forename: R H
authors.initials: RH
authors.lastname: Rosenwasser
authors.forename: P M
authors.initials: PM
authors.lastname: Jabbour
mesh_terms: D000328:Adult; D000368:Aged; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000295:instrumentation*; D004867:Equipment Design; D004868:Equipment Failure; D017809:Fatal Outcome; D005260:Female; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging* / Q000209:etiology*; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D015607:Stents / Q000009:adverse effects*; D013345:Subarachnoid Hemorrhage / Q000209:etiology / Q000517:prevention & control; D017211:Treatment Failure